Provider Demographics
NPI:1437778370
Name:OLIVER, ELAINE (LCPC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11504 JAMESTOWN CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2054
Mailing Address - Country:US
Mailing Address - Phone:301-906-9689
Mailing Address - Fax:
Practice Address - Street 1:11504 JAMESTOWN CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2054
Practice Address - Country:US
Practice Address - Phone:301-906-9689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty